Sexual Offenders' Perceptions of the Client-Therapist Relationship: The Role of Risk

Transformative Learning Theory and Its Application to the Delivery of Community Maintenance Programs for Men Who Have Sexually Offended

Given public perceptions about those who have sexually offended, there tends to be a focus on offence-specific intervention programs in a bid to address re-offending risk. With a significant portion of the literature on sexual offending focused on the development and evaluation of interventions targeting this behavior, there is little that considers community maintenance programs (CMPs) or those programs in the community where those who are released from prison are attempting to reintegrate. Further, there is no known research considering the theoretical underpinnings of or a framework for delivering CMPs. This paper offers Transformative Learning Theory as a potential framework for the delivery of CMPs and offers that adult learning theory needs to be considered in the delivery of offending interventions.

The Risk, Need, and Responsivity Relevance of Working Alliance in a Sexual Offense Treatment Program: Its Intersection With Psychopathy, Diversity, and Treatment Change

The current study examined the self-reported working alliance of men attending a high intensity sexual offense treatment program and its associations with psychopathy, sexual violence risk, treatment change, and recidivism, in a Canadian sample of 317 incarcerated men followed up an average of approximately 10 years post release. Working Alliance Inventory (WAI; Horvath & Greenberg, 1989) self-reported total, Task, Bond, and Goal scores were positively correlated with treatment related changes in risk, and inversely associated with Psychopathy Checklist-Revised (PCL-R; Hare, 1991; Wang & Hare, 2003) scores. The Affective facet of the PCL-R, representing the callous-unemotional features of the syndrome, uniquely predicted lower Bond and Goal scores controlling for the other facets. Cox regression survival analyses demonstrated that sexual violence risk predicted increased sexual recidivism while change predicted decreased sexual recidivism controlling for PCL-R total score; however, WAI scores (particularly the Goal component) were also unexpectedly associated with increased sexual recidivism. For violent recidivism, psychopathy, risk, and change incremented the prediction of general violence, while the WAI was not significantly associated with this outcome. A set of parallel analyses, stratified by Indigenous ethnocultural heritage, demonstrated some continuity, but also potential areas of difference, in substantive findings. Risk, need, responsivity implications of the working alliance for the treatment of high psychopathy correctional clientele, and how this may intersect with Indigenous heritage, are discussed.

Learning From Consumers of Mandated Sex-Offending Programs: "It's Not Treatment, I Wish It Was."

The purpose of this qualitative study was to explore clients' perceptions of sex-offending treatment. The sample included 291 people required to register as sex offenders in the U.S. who answered an open-ended question in an online survey asking them to describe their positive and negative experiences in mandated treatment. Using qualitative analysis, three overarching themes (with several subthemes) were identified: (1) positive and (2) negative treatment experiences and (3) the affiliation between the criminal justice system and clinical services. Experiences in sex offending treatment were viewed as positive when clients had opportunities to learn about themselves, experience group cohesion, build a positive alliance with a caring therapist, learn tools and skills for emotional health, explore the roots of offense behavior, and create healthy life plans to reduce risk for re-offending. Negative themes emerged when treatments were viewed as coercive, confrontational, or demeaning; when therapists seemed inexperienced or unqualified; and when seemingly outdated or unscientific methods were emphasized without explanation or dialogue. The entanglement between court-mandated treatment providers and the criminal justice system led to concerns about confidentiality, conflicts of interest, and role ambiguity. Drawing upon literature related to therapeutic alliance, trauma-informed care, and Risk-Need-Responsivity models, we offer suggestions for integrating client feedback to improve treatment responsivity and prevent re-offending.

The Experience of Working With Individuals Who Sexually Offend

Providing treatment to those who have committed sexual offenses can be difficult and challenging work. Older studies have suggested that service providers may experience changes in mood, symptoms of trauma, and countertransference reactions due to their work. Recent research has found that effective coping and self-care strategies may mitigate these negative outcomes. Given the relative dearth of recent empirical studies, we assessed the prevalence of self-reported mood, trauma symptoms, and countertransference reactions and their relation to coping styles and self-care practices in a sample of 32 male and 52 female therapists who provided treatment to individuals convicted of sexual offenses. As expected, we found minimal levels of clinically significant depressive (4%) and trauma symptoms (9%). Some countertransference reactions to clients were reported, including intense anger, retributive fantasies, sexual attraction, and arousal. A problem-solving coping style was associated with higher levels of psychological well-being, while avoidant coping was related to increased depressive and trauma symptoms. Approximately 10% of therapists with an abuse history reported re-experiencing their own victimization. The majority of therapists reported engaging in self-care practices. The findings are discussed as they pertain to those who provide services to individuals convicted of sexual offenses.

Seen and Not Heard: The Service User's Experience Through the Justice System of Individuals Convicted of Sexual Offenses

User experience and client satisfaction is capturing more attention in the field of social services. The provision of treatment services to individuals convicted of sexual offenses, in particular, has expanded exponentially over the last 20 years. This growing population is now interviewed, interrogated, investigated, assessed, managed, treated, supervised, and surveilled, while their perspective as "service users" is almost entirely absent from research. To that end, this article introduces the service user voice within the context of society's responses to sexual offending. We conducted thematic analysis on secondary data from interviews with 93 individuals. These include 74 men from the United States and 19 men from the United Kingdom, all of whom had been convicted for sexual offenses. The original qualitative data from the two original studies were freshly analysed, inductively and deductively, using Thematic Analysis so that the themes, as well as resulting codes, were appropriate and fit for purpose. Specific themes emerged from each of three clear stages in their service user journey: (a) Interactions with the formal criminal justice system (police, courts, and custodial corrections), (b) Interactions with community corrections (probation and parole), and (c) Interactions with treatment providers (rehabilitation, therapists, and evaluators). We describe the service user experience at each stage and discuss how policy and practice can resolve areas of disconnection. We suggest several ways to promote and privilege the service user voice for those convicted of sexual crimes.

Sexbots as Synthetic Companions: Comparing Attitudes of Official Sex Offenders and Non-Offenders

This is the first Italian study to examine views on sexbots of adult male sex offenders and non-offenders, and their perceptions of sexbots as sexual partners, and sexbots as a means to prevent sexual violence. In order to explore these aspects 344 adult males were involved in the study. The study carried out two types of comparisons. 100 male sex offenders were compared with 244 male non-offenders. Also, sex offenders were divided into child molesters and rapists. Preliminary findings suggest that sex offenders were less open than non-offenders to sexbots, showed a lower acceptance of them, and were more likely to dismiss the possibility of having an intimate and sexual relationship with a sexbot. Sex offenders were also less likely than non-offenders to believe that the risk of sexual violence against people could be reduced if a sexbot was used in the treatment of sex offenders. No differences were found between child molesters and rapists. Though no definitive conclusion can be drawn about what role sexbots might play in the prevention and treatment of sex offending, this study emphasizes the importance of both exploring how sexbots are both perceived and understood. Sex offenders in this study showed a high dynamic sexual risk and, paradoxically, despite, or because of, their sexual deviance (e.g. deficits in sexual self-regulation), they were more inclined to see sexbots as just machines and were reluctant to imagine them as social agents, i.e. as intimate or sexual arousal partners. How sex offenders differ in their dynamic risk and criminal careers can inform experts about the mechanisms that take place and can challenge their engagement in treatment and intervention.

Women parolees' mental health in the context of reintegration

BACKGROUND

Contributing to the literature on reintegration and community supervision, we consider the mental health experiences of women parolees and the implications for case management.

AIMS

We consider the different ways mental health considerations are responded to by parole officers and case management staff, identifying areas of tension (e.g., when psychological services are fused with supervision) but also areas of opportunity (e.g., when case management staff forge therapeutic relationships with parolees).

METHODS

Using a grounded approach we explore women's parole experiences and case management practices through a qualitative analysis of parole and casework documents. Our iterative process of document analysis included content and thematic analysis.

RESULTS

Mental health is responded to both as a therapeutic need and criminogenic risk. Therapeutic responses entail both formal and informal supportive interventions that often appear welcomed by and beneficial to parolees. Risk-based responses fuse mental health considerations into supervisory frameworks, evidenced by the prominence of mental health-related parole conditions and the role of psychologists as assessors of risk.

CONCLUSIONS/IMPLICATIONS FOR CLINICAL PRACTICE

The tension between treatment and supervision can undermine conditions favourable to responsive case management and the working alliance.

An Exploration of Service Providers' Experiences With Latinos Convicted of a Sex Offense

Despite the growing Latino presence in the U.S. criminal justice system and among those who have committed sex offenses specifically, little is known about the barriers and challenges faced by this population when accessing treatment services. This study sought to gather more information about responsivity factors that may be specific to Latinos who have committed sexual offenses. Service providers who worked with Latinos convicted of sexual offenses completed an online survey and answered questions regarding perceived challenges and barriers they encountered when working with Latino clients and were asked to provide recommendations concerning services and treatment provision. Service providers frequently reported issues related to a lack of culturally sensitive services, bilingual professionals, and clients' limited knowledge about the U.S. legal system. Among service providers with experience working with undocumented Latino immigrants, some indicated specific challenges such as stressors related to their immigration status and a lack of resources. Professionals' recommendations were consistent with the challenges reported and findings are discussed as they pertain to responsivity issues in the provision of treatment services to Latino individuals who have committed sexual offenses.

The Virtuous Circle: A Grounded Theory Exploration of the Good Lives Model

Sexual offenses evoke strong emotional responses and frequently elicit demands from society that offenders be indefinitely incarcerated or treated until they are deemed safe, which may impact the provision of therapeutic treatment for offenders. However, in recent years, there has been a proposal to move toward a positive, strengths-based treatment approach, namely the Good Lives Model (GLM). The present study used semi-structured interviews and a constructivist grounded theory approach to examine the experience of 13 men who were voluntarily engaging in or had completed a GLM community-based treatment program. A conceptual model emerged which outlines the process the men underwent, the factors they identified as crucial for change, and the perceived gains. The model extends previous work by exploring the process from the clients' perspective. Implications for future research, prevention, and treatment are discussed.

Therapeutic Climate Within a Treatment Program for Categorical Deniers

The purpose of this study was to examine whether the therapeutic climate within a sex offender "deniers" program, where denial was not challenged, would be equivalent to the therapeutic climate within a conventional program where sex offenders were admitting responsibility. Using a sample of 77 sex offenders, therapeutic alliance and group climate were measured early and late in treatment. As expected, therapeutic alliance was more difficult to attain with deniers early in treatment, particularly therapeutic bond; however, by the end of the treatment, there were no significant differences in therapeutic alliance. There did not appear to be significant differences in group climate early or late in treatment except for the deniers reporting significantly lower levels of open expression of anger and disagreement within the group and, in contrast to the admitters, making significant improvements in group climate over time. Implications for the treatment of categorical deniers and further research suggestions are discussed.

The Role of Psychopathic Traits in the Development of the Therapeutic Alliance Among Sexual Offenders

There is a growing body of research demonstrating that the therapeutic alliance (TA) affects outcomes among specialized forensic populations, including sexual offenders. Despite this consensus, researchers continue to question whether higher levels of psychopathic traits are conducive to the formation of a therapeutic relationship for high-risk sexual offenders. Thus, the current study adds to the literature by examining the relationship between the TA and levels of psychopathy among a sample of incarcerated sexual offenders participating in sexual offender treatment. Overall, we found no significant relationships between Psychopathy Checklist-Revised (PCL-R) scores and the Working Alliance Inventory (WAI) for either client or therapist ratings. However, when we excluded those offenders who were participating in aftercare, a significant negative relationship was found between client ratings of the Bonds subscale and PCL-R total scores. Next, after controlling for risk and group status (aftercare/non-aftercare), we found no significant differences between either client or therapist total WAI scores when compared by level of psychopathy as measured by the PCL-R (low, >20; moderate, 20-30; and high, >30). Furthermore, when Factor 1 and Factor 2 scores of the PCL-R were examined individually, neither factor significantly predicted either client or therapist total WAI score after controlling for risk and group status. Findings are discussed as they pertain to the treatment of sexual offenders with elevated levels of psychopathic traits.

The Impact of Interpersonal Style on Ruptures and Repairs in the Therapeutic Alliance Between Offenders and Therapists in Sex Offender Treatment

The therapeutic relationship is a critical component of psychological treatment. Strain can occur in the relationship, particularly when working with offenders, and more specifically, those offenders with interpersonal difficulties; strain can lead to a rupture, which may affect treatment participation and performance. This study examined ruptures in the therapeutic relationship in sexual offenders participating in offense-focused group treatment. Fifty-four sex offenders rated the therapeutic alliance at the commencement and completion of treatment; at the completion of treatment, they also reported on the occurrence of ruptures and whether they believed these ruptures were repaired. Ruptures were separated by type, according to severity-Each relationship was therefore characterized as experiencing no rupture, a minor rupture, or a major rupture. Offender characteristics including interpersonal style (IPS) and psychopathy were assessed at the commencement of treatment; their relationship with ruptures was examined. Results revealed that more than half of the offenders (approximately 55%) experienced a rupture in the therapeutic alliance, with one in four of these ruptures remaining unresolved. Offenders who did not report a rupture rated the therapeutic alliance significantly higher at the end of treatment compared with those offenders who reported a rupture that was not repaired. Offenders who reported a major rupture in the therapeutic relationship were higher in interpersonal hostility and hostile-dominance. No interpersonal or offense-specific factors affected the likelihood of a rupture repair.

Psychodynamic Treatment of the Criminal Offender: Making the Case for Longer-Term Treatment in a Longer-Term Setting

In recent years, prisons and jails have become de facto psychiatric hospitals, responsible for the care and treatment of individuals with serious mental illness. Historically, cognitive-behaviorally informed therapeutic approaches have been the treatment of choice among mental health practitioners in correctional settings. However, inmate-clients often present with complex diagnostic issues that are arguably better served by long-term treatment options, such as psychodynamic psychotherapy. We first review the nature of psychotherapy in the correctional setting, as well as treatment barriers and challenges faced by both mental health providers and inmate-clients. We then review treatment studies that examine the efficacy of various therapeutic techniques in correctional/forensic contexts. Finally, we argue that, due to the complex nature of psychopathology, average length of time incarcerated, and treatment issues that arise in this multifaceted and challenging setting, mental health treatment providers should consider providing psychodynamic treatment modalities when working with incarcerated individuals. We also argue that more research is needed to examine the efficacy of these treatment approaches with inmate-clients.

Pathways to Desistance Among Men Convicted of Sexual Offenses: Linking Post Hoc Accounts of Offending Behavior and Outcomes

Within many sexual offender-specific treatment programs, clients and their therapists devote considerable time to understanding "cycles" or "pathways" to sexual offending, and clients often need to fit their stories into existing offending paradigms. Although this post hoc processing of offending behaviors may assist clients in understanding their individual pathway toward crime, we know little about how they situate this information within their lives moving forward. Relying on in-depth interview data, the current study examined accounts of the sexually related crimes that brought 28 men to prison. Analyses suggest varied perspectives among the men regarding pathways to and from their sexual offenses; some aligning with existing models, but others merging around different theoretical frameworks. Implications are discussed as they relate to treatment models and the desistance process for men convicted of sexual offenses.